Dementia

Dementia is a cognitive dysfunction in which memory, attention span, and problem solving are affected. The most common types of dementia is Alzheimer’s disease (AD); however, other types include multi-infarct dementia, Lewy body dementia, Pick’s disease, alcohol related dementia, and other unusual types.

AD results from the degeneration of the nerve cells and the deposit of specific proteins within the brain cells. The typical presentation is slowly progressive loss in memory, problem solving, and cognitive dysfunction. The patient is noticed to forget names of close family members, repeating themselves, forgetting doing things they have done a few minutes earlier, getting lost driving, inability to balance checkbook and other symptoms.

The diagnosis of AD is based on the clinical presentation; however, tests are done to rule out any other diseases that mimic AD. Typical workup includes MRI, metabolic workup (blood work) and possible EEG. It essential to rule out and diagnose other types of dementia since the treatment and progression can be different from AD.

There are two classes of medications approved for AD; acetylcholine esterase inhibitors (Aricept and Exelon) and glutamate receptor modulator (Namenda). In addition, B vitamins can be helpful such as Cerefolin with NAC or over-the-counter B complex. These medications do not produce an immediate effect seen on day-to-day bases but instead they slow the progression of the disease over the years. Family education about AD and counseling is essential in managing the patient.

AD can also have associated sequelae or symptoms in addition to the memory including agitation, delusions, insomnia, and/or sleep disorders. These conditions are treated be addressed accordingly.